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Market Research Report

Global Healthcare Fraud Detection Market - Segmented by Type of, Application, End User, and Geography - Growth, Trends, and Forecast (2018 - 2023)

Published by Mordor Intelligence LLP Product code 704946
Published Content info 125 Pages
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Global Healthcare Fraud Detection Market - Segmented by Type of, Application, End User, and Geography - Growth, Trends, and Forecast (2018 - 2023)
Published: August 1, 2018 Content info: 125 Pages

Healthcare Fraud Detection Market
Size - Segmented by Type of (Descriptive Analytics, Predictive Analytics, Prescriptive Analytics), Application (Review of Insurance Claims, Payment Integrity), End User (Private Insurance Payers, Government Agencies, and Employers), and Geography - Growth, Trends, and Forecast (2018 - 2023).

The global Healthcare Fraud Detection Market is expected to register a CAGR of 27.5% during the forecast period, 2018 to 2023. With the rise in health care fraud, there are changing government regulations to curb fraud. Many companies that apply analytical tools to detect the false claim records are improving the revenue of hospitals. This trend is expected to continue in the forecast period and will have a positive effect on healthcare fraud detection market.

Prepayment Review Model

The prepayment review model has revolutionized the healthcare landscape. Medicare claims are now reviewed by prepayment reviews. By this, the Center for Medicare and Medicaid Services (CMS) can save money and reduce the burden on hospitals. The prepayment review model will improve the system-wide process improvements, and has a significant impact on the cash flow of hospitals. This model allows the government to hold the money until the claim submitted be confirmed as valid.

With this model there is a huge burden on hospitals as the number of claims subject to review will dramatically increase. On the positive note hospitals no longer worry about audits after receiving payment as cash flow is stopped until the errors in claims are correct. This a great help for a hospital with an expert team for error-free claim submission can generate cash flow hassle free. Many hospitals are making system-wide operations improvements for accurate documentation and are adopting predictive modeling techniques.

The other factors such as a rise in the number of patients opting health insurance, growing pressure to increase in operations efficiency and reduce health care spending, and increasing fraudulent activities in healthcare are driving the Healthcare Fraud Detection Market.

Unwillingness to Adopt Healthcare Fraud Analytics

In healthcare, fraud analytics are used are used to detect duplication of claims with the use of analytics. Insurance companies review huge data such as medication history, disease history, and surgical procedures underwent etc. Companies that are unwilling to adopt new analytics technologies used in detection market are hampering its market growth

In developing countries where the IT systems, technological advancements in medical record databases are not well developed and lack of proper regulations to combat privacy issues there is a high chance of confidentiality. The above is a major factor that has restrained the growth of the Healthcare Fraud Detection Market.

The US Lead the Market in the North America Region

The US Healthcare Fraud Detection Market holds the largest market share in 2017 in North America region due to the growing pressure to curb fraud cases and minimize healthcare spending. In the United States, most health care providers are subject to extensive and frequently changing local, state and federal laws and regulations relating to healthcare fraud and abuse. State and federal governments strengthen their position and scrutiny over practices involving fraud that is affecting Medicare, Medicaid, and other government healthcare programs. The Patient Protection and Affordable Care Act greatly increased the insured population along with the rise of fraudulent claims. To comply with regulations and prevention of fraudulent claim for payment to, and knowing retention of an overpayment by, a federal healthcare program such as Medicare and Medicaid many organizations are employing new analytical solutions. This is likely to contribute towards the growth of the Healthcare Fraud Detection Market.

Key Developments in the Market

  • Jun 2018: SCIO Health Analytics, is certified on Veeva CRM MyInsights and provides unique insights on patient risks and impactability, and profile the types of patients treated within a site of care through it's advanced predictive and prescriptive analytics capabilities.

Reasons to Purchase the Report

  • Current and future Healthcare Fraud Detection Market outlook in the developed and emerging markets
  • Analysis of various perspectives of the market with the help of Porter's five forces analysis
  • The segment that is expected to dominate the market
  • Regions that are expected to witness the fastest growth during the forecast period
  • Identify the latest developments, market shares, and strategies employed by the major market players
  • 3-month analyst support, along with the Market Estimate sheet (in Excel)

Customization of the report

This report can be customized to meet your requirements. Please connect with our representative, who will ensure you to get a report that suits your needs

Table of Contents
Product Code: 64040

Table of Contents

1. Introduction

  • 1.1. Market Definition

2. Research Methodology

3. Executive Summary

4. Key Inferences

5. Market Overview

  • 5.1. Current Market Scenario
  • 5.2. Porter's Five Forces Analysis
    • 5.2.1. Bargaining Power of Suppliers
    • 5.2.2. Bargaining Power of Consumers
    • 5.2.3. Threat of New Entrants
    • 5.2.4. Threat of Substitute Product and Services
    • 5.2.5. Competitive Rivalry within the Industry

6. Market Dynamics

  • 6.1. Healthcare Fraud Detection Market Drivers
    • 6.1.1. Prepayment Review Model
    • 6.1.2. Rise in Number of Patients Opting Health Insurance
    • 6.1.3. Growing Pressure to Increase in Operations efficiency and Reduce Healthcare Spending
    • 6.1.4. Increasing Fraudulent Activities in Healthcare
  • 6.2. Healthcare Fraud Detection Market Restraints
    • 6.2.1. Unwillingness to Adopt Healthcare Fraud Analytics
  • 6.3. Healthcare Fraud Detection Market Opportunities
  • 6.4. Healthcare Fraud Detection Market Challenges

7. Market Segmentation

  • 7.1. Healthcare Fraud Detection Market By Type of
    • 7.1.1. Descriptive Analytics
    • 7.1.2. Predictive Analytics
    • 7.1.3. Prescriptive Analytics
  • 7.2. Healthcare Fraud Detection Market By Application
    • 7.2.1. Review of Insurance Claims
    • 7.2.2. Payment Integrity
  • 7.3. Healthcare Fraud Detection Market By End User
    • 7.3.1. Private Insurance Payers
    • 7.3.2. Government Agencies
    • 7.3.3. Employers
  • 7.4. Healthcare Fraud Detection Market By Geography
    • 7.4.1. North America
      • United states
      • Canada
      • Mexico
    • 7.4.2. Europe
      • France
      • United Kingdom
      • Germany
      • Spain
      • Italy
      • Rest of Europe
    • 7.4.3. Asia-Pacific
      • India
      • China
      • Japan
      • Australia
      • South Korea
      • Rest of Asia-Pacific
    • 7.4.4. Middle East Africa
      • GCC
      • South Africa
      • Rest of Middle East & Africa
    • 7.4.5. South America
      • Brazil
      • Argentina
      • Rest of South America

8. Healthcare Fraud Detection Market Company Profiles & Competitive Landscape

  • 8.1. Scio Health Analytics
  • 8.2. IBM
  • 8.3. Mckesson
  • 8.4. Optum
  • 8.5. SAS Institute
  • 8.6. CGI Group
  • 8.7. Northrop Grumman
  • 8.8. Lexinexis
  • 8.9. DXC Technology
  • 8.10. Verscend Technologies

* List Not Exhaustive.

9. Future of the Healthcare Fraud Detection Market

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